Primary & Secondary Survey:


The Primary Survey, or initial assessment, is designed to help the emergency responder detect immediate threats to life. Immediate life threats typically involve the patient's ABCs, and each is correct as it is found.


Life threatening problems MUST be identified first. This is to be completed in an order of priority to ensure the most important steps are undertaken in a logical order ensuring nothing is missed. This systematic approach uses the acronym DRABC.


D: Danger:

  • Ensure safety for yourself and any others. Do not put yourself at risk.
  • Remove danger or move the patient.
  • Find out what has happened from witnesses if possible. Get information.


R: Response:

  • Assess the patient’s level of consciousness using the AVPU score (see levels of response AVPU).

Note: The presence of dementia in the elderly patient can make it hard to accurately assess the mental status and the responder should utilise family/carers to obtain baseline information.


A: Airway:

  • Look into their mouth, if any liquid is found place the patient on their side and drain the liquid (postural drainage).
  • Place patient back onto their back and open the airway using a head tilt/chin lift techniques.


B: Breathing:

  • Place your ear over the patient's mouth and look, listen and feel for 10 seconds.
  • Ask yourself is the patient breathing normally, and not taking occasional gasps of air.
  • If patient is breathing normally carry out a secondary survey.
  • If in any doubt patient is breathing normally dial 999.
  • Asses the patient's circulation (pulse and bleeding) if needed start chest compressions or defibrilation (see below).


C: Compressions

  • Start chest compressions. Depth 5-6cm. Rate of 100-120 per minute combined with two mouth-to-mouth inflations.
  • Continue at 30 compressions then two mouth-to-mouth inflations (mouth-to-mouth is still the gold standard treatment).
  • If unwilling to or unable to perform mouth-to-mouth continue with chest compressions only, until paramedics arrive.
  • Remember that the elderly often have an irregular pulse which is rarely life threatening, however the speed of the pulse i.e. too fast or too slow, can be life threatening.



  • Attach an AED (Automatic External Defibrillator) as soon as it arrives, if available at your workplace. Follow voice prompts.



  • Patient should be on a hard surface to allow you to perform quality chest compressions, beds are not ideal. Be careful not to injure yourself removing then from a bed.



Any resuscitation is better than no resuscitation at all.



A focused history and physical exam should be performed after the initial assessment. It is assumed that the life threatening problems have been found and corrected. If that process involved CPR you may not get to this stage.


The focused history and physical exam includes examination that focuses on specific injury or medical complaints, or it may be a rapid examination of the entire body as follows, which should take no more than 3 minutes.


The secondary survey is a systematic approach to identify any bleeding or fractures. This system starts at the head and works down to legs.


  • Bleeding: Carryout out a head to toe check for bleeding.
  • Head & Neck: Clues to look out for are: bruising, swelling, deformity or bleeding (See Spinal Injuries).
  • Shoulders & Chest: Place both hands on opposite shoulders, run them down comparing both sides of the body. (See Fractures & Dislocation).
  • Abdomen & Pelvis: Place palm of hand onto abdomen and push gently checking for painful responses from patient.
  • Legs & Arms: Using both your hands compare both arms and legs for fractures, dislocations, look also for medic alerts.
  • Pockets: Look for clues, ID medical jewellery, such as medic alerts which might indicate any existing medical condition. 
  • Recovery Position: If patient is unconscious place them in the recovery position (see Recovery Position).


It also includes obtaining a patient history and vital signs and the acronym used for this is SAMPLE:


  • S = Signs & symptoms.
  • A = Allergies.
  • M = Medications.
  • P = Pertinent past medical history.
  • L = Last oral intake.
  • E = Events leading to the illness or injury.

We hope you find this article useful. This is one in an alphabetical series of articles addressing various symptoms and their first aid treatments. If you would like more information on related resuscitation and first aid training, please get in touch.


You might also be interested in our blog. In this particular post, Sheila Mitchard explains why being a paramedic is like being a detective inspector.


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